Tamoxifen: Tablet vs. Injection Preferences Studied
Many breast cancer patients who are using hormone therapies such as tamoxifen to cut the risk of recurrence prefer tablets over injections, given a choice, says a new report in the Annals of Oncology.
But if injections could reduce hot flashes, a side effect of such treatments, more than 60 percent of the women surveyed said they would choose the injections.
And if the injections would better control the cancer than the tablets do, 74.5 percent would pick the injections.
The findings also reveal that women often skipped their hormone treatments in tablet form.
"The take-home message is that unless we find some way of helping women with breast cancer deal effectively with their hot flashes and other menopausal side effects, then optimal doses of anti-cancer drugs may not be reaching the patients," says Lesley Fallowfield, Ph.D., lead author of the study and researcher at Brighton & Sussex Medical School at the University of Sussex.
In the study, Dr. Fallowfield's team interviewed 208 women with early or advanced stage breast cancer who had been diagnosed at least two years before.
When they were asked which medicine form they would prefer if daily tablets or a double injection once a month were equally effective and had equal side effects, 63 percent picked tablets, 24.5 percent chose injections and 12.5 percent had no preference.
But when presented with a hypothetical scenario in which the injection of hormone treatments produced fewer hot flashes, the responses changed, with only 27.4 percent choosing tablets and 60.6 percent picking the injections. Another 12 percent had no preference.
And when presented a scenario in which the injections better controlled the cancer, even more, 74.5 percent, chose the injections.
Those who picked tablets in the initial scenario said they were more convenient; and some said they disliked needles. Those who preferred injections said they were more convenient and it was easier to comply with the therapy.
But Dr. Fallowfield and her team also found that taking the tablets as prescribed did not always happen.
Of the women who admitted they skipped their tablets, 48.7 percent said they sometimes forgot, and 13.1 percent admitted they deliberately did not take their tablets some of the time.
The fact that women sometimes missed taking the tablets was no surprise to Dr. Patricia Ganz, director of cancer prevention and control research at the University of California, Los Angeles Jonsson Comprehensive Cancer Center.
"Non-adherence to medication is common," she says, although "women with breast cancer are more motivated [than some others] to take their medication."
But the degree of non-adherence was of concern to Dr. Fallowfield.
"We were very surprised to see the level of non-adherence to tablet taking in women with life-threatening disease," she notes, "and the fact that 25 percent preferred injections to ensure compliance."
Prescribing hormone treatment in tablet form rather than shots is standard practice, comments Dr. Ganz.
"Right now there is no injectable that does not cause hot flashes," she adds.
Always consult your physician for more information.
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Younger women with a certain type of early-stage breast cancer do better on five years of tamoxifen than those who stop treatment after two years, researchers report in the medical journal Cancer.
Although it took nine years for the benefits to appear, investigators found that longer-term treatment makes a significant difference in the overall survival of women ages 55 and younger who have "estrogen receptor positive" tumors.
Five years of treatment was associated with a 44 percent reduction in the risk of death among these women.
"Our study confirms that these women have to know that the longer use of tamoxifen is a great weapon to fight their battle," says study co-author Dr. Miriam Valentini, a staff scientist in the Laboratory of Clinical Epidemiology of Diabetes and Cancer at Consorzio Mario Negri Sud in Santa Maria Imbaro, Italy.
Breast cancers that need the female hormone estrogen to grow are known as estrogen receptor (ER) positive. The medication tamoxifen helps prevent the growth of estrogen-sensitive breast tumors.
When used as an additional therapy for treating early-stage breast cancer, tamoxifen is usually prescribed for five years, although the National Cancer Institute (NCI) states the ideal length of treatment is not known.
To test whether duration makes a difference in treating early-stage breast cancer, researchers randomly assigned 1,901 patients to stop tamoxifen after two years or receive an additional three years of drug therapy.
The benefits of longer therapy on overall survival of ER-positive patients only started to emerge after nine years from diagnosis of the disease. And within that group, only younger women benefited.
V. Craig Jordan, scientific director for medical science at Fox Chase Cancer Center in Philadelphia, says the difference between younger and older women is in their endocrinology.
"In pre-menopausal women, they are awash in estrogen," he explains, and that hormone's relationship to breast cancer is like that of lighter fluid to fire.
"You need five years (of tamoxifen) to act really as the fire blanket to keep all this estrogen away," he adds, noting that older women, by contrast, need less.
That is not to say older women should stop treatment after two years. Physicians should carefully weigh the risks and benefits for women over 55, including the known side effects of endometrial cancer and blood clots, Dr. Valentini notes.
"After a careful evaluation of these aspects, they can decide if, for an individual patient, it is suitable to prolong therapy with this drug or to use another hormonal drug," she adds.
Always consult your physician for more information.
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